[Clinical features and efficacy analysis of different treatment modalities for type Ⅰ and Ⅱ spontaneous extracranial...

Objective: To compare the clinical features of different treatment strategies between patients with type Ⅰ and type Ⅱ spontaneous extracranial carotid artery dissection (sECD). To investigate the efficacy of different treatment methods. Methods: A retrospective analysis was conducted on 181 sECD patients admitted to the First Affiliated Hospital of Zhengzhou University between June 2018 and February 2025, of whom 23 had bilateral involvement, resulting in a total of 204 dissected vessels. Based on the Borgess classification, 204 dissected vessels were categorized into 2 groups: type Ⅰ (intact intima, 71 vessels) and type Ⅱ (with an intimal tear, 133 vessels). Patients were followed up at 3, 6, and 12 months, and every 12 months thereafter via outpatient visits or readmission. Demographic data, clinical manifestations, imaging features, treatment regimens, and follow-up data were collected to analyze and compare the incidence of cerebral ischemic events, cerebral hemorrhage, and mortality during hospitalization and follow-up between the 2 groups. To observe the efficacy between surgical and conservative treatments as well. Results: A total of 181 patients aged (50±11) years were included, comprising 139 males and 42 females. Compared with type Ⅱ sECD, type Ⅰ were younger [48 (40, 56) vs 51 (44, 57) years, P=0.043] and had higher National Institute of Health Stroke Scale scores at admission and discharge [2 (0, 5) vs 0 (0, 3) points, P=0.029; and 0 (0, 2) vs 0 (0, 1) points, P=0.026, respectively]. The incidence of ischemic stroke was significantly higher in type Ⅰ sECD [60.6% (43/71) vs 43.6% (58/133), P=0.021]. Type Ⅰ sECD also exhibited a higher proportion of true lumen stenosis >70% [78.9% (56/71) vs 36.8%(49/133), P<0.001]. A total of 67 patients (71 vessels) underwent surgical treatment with a 100.0% (71/71) success rate and no perioperative complications. Among 114 patients (133 vessels) receiving conservative treatment, the cerebral ischemia recurrence rate was 3.7% (2/53) for type Ⅰ and 6.3% (5/80) for type Ⅱ, with no statistically significant difference (P>0.05). However, the complete and partial healing rates were higher in type I sECD than in type Ⅱ [88.7% (47/53) vs 30.0% (24/80), P<0.001]. Conclusions: Type Ⅰ sECD is more common in younger patients and is associated with a higher risk of severe ischemic stroke, yet it exhibits better healing rates with antithrombotic therapy. Surgical treatment intervention is safe and effective for both types.